内镜治疗非静脉曲张上消化道出血随机对照试验的Meta分析

Endoscopic hemostasis for non-variceal upper gastrointestinal bleeding: a Meta-analysis of randomized controlled trials

摘要:

比较不同内镜方式治疗非静脉曲张上消化道出血（NVUGB）的效果。方法 在Pubmed、Web of Science、Embase、Cochrane Library、中国生物医学文献数据库、中国知网数据库、万方数据库和维普数据库检索自建库以来至2018年11月公开发表的、有关内镜治疗NVUGB的所有中英文随机对照试验（RCT），对纳入的研究进行质量评价，采用Revman 5.3软件进行Meta分析。结果 经过文献筛选后，共37篇RCT最终被纳入分析，共3 064例患者。Meta分析结果显示，金属钛夹与药物局部注射比较，即时止血成功率高（RR=1.12，95%CI：1.04～1.21）、再出血率低（RR=0.30，95%CI：0.22～0.42）、急诊外科手术率低（RR=0.24，95%CI：0.13～0.42）；金属钛夹与热凝止血比较，再出血率低（RR=0.32，95%CI：0.16～0.65）、即时止血成功率差异无统计学意义（RR=0.96，95%CI：0.89～1.05）、急诊外科手术率差异无统计学意义（RR=0.43，95%CI：0.15～1.25）；热凝止血与局部药物注射比较，即时止血成功率差异无统计学意义（RR=1.02，95%CI：0.98～1.05）、再出血率差异无统计学意义（RR=0.98，95%CI：0.76～1.27）、急诊外科手术率差异无统计学意义（RR=1.03，95%CI：0.75～1.41）。结论 内镜下金属钛夹治疗NVUGB的疗效优于药物局部注射和热凝止血，具有临床推广和应用价值。

Abstract:

We conducted a systematic review and Meta-analysis to compare the effectiveness of different endoscopic treatments on non-varicose upper gastrointestinal bleeding. Methods Pubmed, Embase, Cochrane Library, Web of Science, CBM, CNKI, CQVIP and WanFang data were systematically searched for eligible studies that compared the effectiveness of different endoscopic treatments. The search was limited to papers published since the establishment of the database until November 2018. Study selection was performed according to predefined criteria. We evaluated the quality of included studies, then Meta-analysis was conducted using RevMan 5.3 software. Results Eventually, 37 RCTs including 3064 patients were identified. The results of the Meta-analysis showed: Compared with local drug injection, the success rate of initial hemostasis was higher (RR = 1.12, 95%CI: 1.04 ~ 1.21). The rebleeding rate (RR = 0.30, 95%CI: 0.22 ~ 0.42), and the emergency surgery rate were lower (RR = 0.24, 95%CI: 0.13 ~ 0.42) in the clipping group. Compared with the thermo-coagulation, the rebleeding rate (RR = 0.32, 95%CI: 0.16 ~ 0.65) was lower in the clipping group. There were no significant difference in the success rate of initial hemostasis (RR = 0.96, 95%CI: 0.89 ~ 1.05) and the emergency surgery rate (RR = 0.43, 95%CI: 0.15 ~ 1.25) between the clipping group and the thermo-coagulation group. There were no significant difference in the success rate of initial hemostasis (RR = 1.02, 95%CI: 0.98 ~ 1.05), the rate of rebleeding (RR = 0.98, 95%CI: 0.76 ~ 1.27), and the rate of emergency surgery (RR = 1.03, 95%CI: 0.75 ~ 1.41) between the thermo-coagulation group and the local drug injection group. Conclusion The therapeutic effect of endoscopic hemoclip on upper gastrointestinal bleeding is better than that of local injection and thermal coagulation, which has clinical application value.